Credentialing Specialist Managed CareAltamonte Springs, FL

AdventHealth Corporate Credentialing Specialist

Hospitals, medical centers, and facilities need more than physicians, nurses, and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady, and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety, and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional, and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind, and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam, and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

All the benefits and perks you need for you and your family:

Benefits from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Shift: Monday-Friday Full time 8am-5pm

Job Location: Remote

The role you will contribute:

Responsible for coordinating, monitoring, and maintaining the credentialing and re-credentialing process. Facilitates all aspects of Adventist Health Systems (AHS) credentialing, including initial appointment, reappointment, expirables process of physicians and allied health professionals, and all other providers outlined in AHS policies, or related contracts. Ensures interpretation and compliance with the appropriate accrediting and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing. Responsible for the accuracy and integrity of the credentialing database system and related applications.

The value you will bring to the team:

• Coordinates, and monitors the review and analysis of practitioner applications and accompanying documents, ensuring applicant eligibility.
• Conducts thorough background investigation, research, and primary source verification of all components of the application file and ensures provider files are current and noted in detail in the system of record.
• Achieves productivity standards as determined by management.
• Identifies issues that require additional investigation and evaluation, validates discrepancies, and ensures appropriate follow up.
• Prepares credentials file for completion and presentation to the AHS Delegated Credentialing Committee (DCC) or other affiliated credentialing committees within AHS, including Clinically Integrated Network (CIN) committees ensuring file completion within time periods specified.
• Processes requests for privileges, ensuring compliance with criteria outlined in clinical privilege descriptions.
• Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing and privileging issues as they arise.
• Assists with managed care delegated credentialing audits; conducts internal file audits.
• Utilizes the MSOW/Apogee credentialing database, optimizing efficiency, and performs query, report and document generation; submits and retrieves National Practitioner Database reports in accordance with Health Care Quality Improvement Act.
• Monitors the initial, reappointment, and expirables process for all AHS employed physicians, allied health professional staff, other health professional staff, delegated and community CIN providers affiliated with AHS. Responsible for ensuring compliance with regulatory bodies (Joint Commission, NCQA, CMS, federal and state), as well as medical staff bylaws, rules and regulations, policies and procedures, and delegated contracts.
• Performs miscellaneous job-related duties as assigned.

The expertise and experiences you'll need to succeed:

High School Grad or Equiv

Attentive to detail and accuracy; strong organization skills required.

Ability to communicate effectively, both orally and in writing.

Program planning and implementation skills.

Knowledge of related accreditation and certification requirements.

Knowledge of medical credentialing and privileging procedures and standards.

Ability to analyze, interpret, and draw inferences from research findings, and prepare reports.

Working knowledge of clinical and/or hospital operations and procedures.

Informational research skills.

Ability to use independent judgment to manage and impart confidential information.

Database management skills including querying, reporting, and document generation.

Ability to make administrative/procedural decisions and judgments.

Certified Professional Medical Staff Management (CPMSM) Required Or

Certified Provider Credentialing Specialist (CPCS) Required

Additional Licenses and Certifications actively pursuing certification by NAMSS Certification

1 Administrative support in a healthcare setting.

Preferred Qualifications:

MSOW/Apogee

Typing 35 wpm

MS Office (Excel, Word, Outlook)

This facility is an equal opportunity employer and complies with federal, state, and local anti-discrimination laws, regulations, and ordinances.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25027150

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age, or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits, and other terms and conditions of employment.